Why Does the President’s Budget Cut Critical Services for Women with HIV and AIDS?

President Obama’s proposed budget, released last month, was reasonably true to his Administration’s commitment to working toward an AIDS-free generation. But one key disappointment was his proposed cut of 10 percent to the Ryan White Part D budget. This is the only part of the program that serves the unique needs of women, children, youth and families–and the only Part of the program to take a hit.

Part D programming was essential in its early years to provide care and support to HIV-positive women caring for HIV-positive babies and children. When it was discovered in 1994 that medication to a pregnant woman and the subsequent newborn could dramatically reduce mother-to-child transmission (MTCT), Part D programs played a critical role in making such interventions more accessible, a necessary step to eliminating MTCT.

Despite this progress, Part D remains as relevant as ever. Women living with HIV and AIDS face unique challenges to their medical care and treatment: they are overwhelmingly low-income, and the vast majority are caregivers. One study found that nearly two-thirds of women with HIV had annual incomes below $10,000, as compared to about 40 percent of men. The same study revealed that three-quarters of women living with HIV and AIDS and receiving medical care had minor children at home. For these and other reasons, women living with HIV or AIDS are less able to access care and remain in care than men. In fact, women infected by HIV are less likely to receive necessary medication, are more likely to postpone care because they lack transportation or are too sick to go to the doctor, and have higher rates of hospitalizations than men. At the same time, women’s clinical and symptomatic experience of HIV is different from that of men, resulting in distinct medical needs.

The National HIV/AIDS Strategy (“NHAS”), released in July 2010, noted that “people with competing demands and challenges meeting their basic needs for housing, food, and child care often have problems staying in care.” Recognizing the connection between effective treatment and prevention, the NHAS Implementation Plan underscores the positive role of social services in prevention strategies. The Implementation Plan encourages “policies to promote access to housing and supportive services… that enable people living with HIV to obtain and adhere to HIV treatment.”

Timely connection to and retention in medical care correlates with better individual health outcomes for women living with HIV and AIDS, and better public health outcomes. Retention in care is associated with improved immune response, decreased infectiousness, and improved survival rates. Additionally, patients who receive routine medical care are significantly less likely to engage in HIV risk behaviors. A recent groundbreaking study also found that early and regular treatment virtually eliminated the risk of transmission between sero-discordant, heterosexual partners.

Programs like those funded by Ryan White Part D are essential to ensuring that women living with HIV/AIDS are connected to care, and stay in care. While other parts of the Ryan White program must spend at least 75 percent of their funds on medical services, Part D is exempt from this requirement. This exception reflects an understanding that social services — like transportation to a doctor’s appointment, a regular supply of healthy food, and case management– are critical to keeping women in care. These programs in turn improve individual health outcomes and reduce HIV transmission.

If President Obama is truly committed to an AIDS-free generation, then he cannot sacrifice Ryan White Part D programs.